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Carpal Tunnel Syndrome

New Approach in the Surgical Management of Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common problem especially in middle aged women. The usual presentation is numbness and pain of the the thumb, index and middle fingers. The numbness may come on early in the morning waking the patient up. She has to get up to shake her hands before the numbness goes off. The numbness can also come one with repetitive activities such as computer use, laundering or excessive writing. Sometimes it occurs when using the phone or when the newspaper is held up while reading.

Untreated, the patient may develop difficulty in buttoning clothes or picking up small objects or she may drop objects such as cups.

In some cases it occurs during pregnancy or after but these cases usually resolves after delivery.

The cause of the problem is compression of a nerve, the median nerve, at the wrist by a ligament named the flexor retinaculum across the wrist. The inhibits normal blood flow through the nerve causing the symptoms.

To confirm the diagnosis, an electromyographic study is done. This consists of attaching electrodes to the finger and wrist. A small electrical current is transmitted to test if there is an obstruction of the median nerve at the wrist.

Conservative treatment consists of medication, bracing and restriction of activities that bring on the symptoms. However, if these fails and symptoms are disturbing, surgery would be suggested.

Conventional surgery consist of making a skin ncision over the nerve of about 2 to 3 cm to cut through the ligament to release the pressure on the nerve.

New Approach

A new approach which is used today is to use a keyhole (minimal access operation). The consist of making a small cut of about ¾ centimeter over the wrist. A special instrument, the Knifelite®, is used to release the ligament. The procedure is done as an office procedure (that is, in the doctor’s clinic) under local anesthesia. No special preparation is required pre-operatively (that is the patient need not be starved for 6 hours prior to the procedure). The actual surgery takes about 3 to 5 minutes. The nerves around the area is blocked off post-surgical so that there is minimal pain which can be controlled with oral pain-killers. The dressing is changed the next day and the patient can resume light work and driving. The stitches are removed after 10 to 14 days.

The new procedure is less painful and is much more comfortable for the patient and since it does not involve any hospital stay, hospital cost is avoided. The final result is no different from the previous open surgery.

The Instrument used for the minimal access (keyhole) surgery: the Knifelite